To evaluate the incidence, diagnosis, and management of serious urinary complications after major operative laparoscopy.For this retrospective study of 953 consecutive cases of major operative laparoscopy from January 1, 1990, to December 31, 1994, we reviewed incidence, method of diagnosis, and management of complications. Urinary complications included bladder injuries, urinary fistulas, and ureteral injuries. Major operative laparoscopic procedures included hysterectomy, adnexectomy, treatment of tubal pregnancy, ovarian cystectomy, and ablation-fulguration of severe endometriosis (stage IV).Serious urinary complications were found during or after operative laparoscopy in 15 of 953 patients (1.6%, 95% confidence interval [CI] 0.8-2.4). Four ureteral injuries, three bladder fistulas, and eight bladder perforations were documented in this series. Eight cases of urinary complications were recognized during the original surgery (one ureteral injury and seven bladder injuries) and repaired at that time. Laparotomy or additional major surgery was performed in seven patients (three ureteral injuries, two bladder fistulas, and two bladder perforations).Serious urinary complications after major operative laparoscopy were discovered in 1.6% of patients. This incidence compares favorably to serious urinary complications after standard gynecologic surgery. Intraoperative recognition of these complications will likely avoid additional surgery.
Background Many patients receiving oral iron for iron deficiency anemia ( IDA ) cannot tolerate or fail to respond to therapy, and existing intravenous ( IV ) iron formulations often require repeated administrations. Ferric carboxymaltose ( FCM ), a nondextran IV formulation, permits larger single doses. Study Design and Methods We evaluated FCM versus oral iron in IDA patients. After 14 days of oral iron, 507 participants responding inadequately to oral iron (hemoglobin [Hb] increase <1 g/ dL ; Cohort 1) were assigned to Group A (two doses of FCM , 750 mg, 1 week apart) or Group B (oral iron, 325 mg, 3 × day for 14 additional days). Also, 504 subjects not appropriate for oral iron (Cohort 2) were assigned to Group C ( FCM as above) or Group D (standard‐of‐care IV iron). The primary efficacy endpoint was change to highest observed Hb from baseline to Day 35. The composite safety endpoint included all‐cause mortality, nonfatal myocardial infarction, nonfatal stroke, unstable angina, heart failure, arrhythmias, and hyper‐ or hypotensive events. Results Mean (± standard deviation [ SD ]) Hb increase was significantly greater in Group A– FCM than Group B–oral iron: 1.57 (±1.19) g/ dL versus 0.80 (±0.80) g/ dL (p = 0.001). Post hoc comparison of Group C – FCM and Group D –IV standard of care also demonstrated significant mean (± SD ) increase in Hb from baseline to highest value by Day 35 in Group C versus Group D: 2.90 (±1.64) g/ dL versus 2.16 (±1.25) g/dL (p = 0.001). Safety endpoints occurred in 17 of 499 (3.4%) participants receiving FCM versus 16 of 498 (3.2%) in comparator groups. Conclusion Two 750‐mg FCM infusions are safe and superior to oral iron in increasing Hb levels in IDA patients with inadequate oral iron response.
A group of 173 patients with abnormal cervical cytology underwent diagnostic or therapeutic conization following colposcopic examination. The series includes 23 patients with cold knife conization in the hospital under general anesthesia, 12 patients with an outpatient KTP laser procedure under local anesthesia, 53 patients with an outpatient CO2 laser procedure under local anesthesia, 10 patients with hospital-based loop radiothermal cautery conization and 75 patients with loop radiothermal cautery conization in the office under local anesthesia. Loop radiothermal cautery conization was advantageous, with a shorter duration of surgery, lower cost, reduced operative bleeding, less of a need for pain-relieving medication and shorter duration of postoperative disability. Cold knife conization patients had the most intraoperative bleeding and the longest hospitalization. KTP laser conization produced specimens of inferior quality, resulting in the least satisfactory histologic diagnosis. Office-based loop radiothermal cautery conization may be preferable to other methods of conization in the diagnosis and management of squamous intraepithelial lesions.
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